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Neonatal refeeding syndrome and postnatal growth in extremely low birth weight infants

Kyoung Eun Joung1, Michael Prendergast2, Olivia Marchioni3

  • 1Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center (CUIMC), New York, NY, USA. kj2621@cumc.columbia.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association
|August 11, 2026
PubMed

Insights

Neonatal refeeding syndrome (RS) in extremely low birth weight (ELBW) infants is linked to poor growth and bronchopulmonary dysplasia (BPD). Early electrolyte monitoring is crucial for these vulnerable newborns.

Area of Science:

  • Neonatology
  • Pediatric critical care
  • Biochemistry

Background:

  • Extremely low birth weight (ELBW) infants are at high risk for electrolyte imbalances and refeeding syndrome (RS).
  • Small for gestational age (SGA) infants may have distinct metabolic trajectories in the neonatal period.
  • Understanding the impact of RS on clinical outcomes is essential for optimizing care.

Purpose of the Study:

  • To compare first-week electrolyte and glucose levels between small for gestational age (SGA) and non-SGA infants.
  • To investigate the association between neonatal refeeding syndrome (RS) and subsequent growth and clinical outcomes in ELBW infants.

Main Methods:

  • Retrospective cohort study including 122 ELBW infants.
  • Analysis of first-week trajectories of phosphorus, potassium, magnesium, calcium, and glucose.
  • Evaluation of the correlation between RS severity and growth failure and bronchopulmonary dysplasia (BPD).

Main Results:

  • High incidences of hypophosphatemia (38.5%), hypokalemia (19.7%), and hyperglycemia (49.2%) were observed.
  • SGA infants exhibited significantly lower phosphorus, potassium, and magnesium levels during the first week compared to non-SGA infants.
  • RS severity was associated with growth failure (weight <10th percentile at NICU discharge) and BPD, despite faster initial weight recovery.

Conclusions:

  • Neonatal refeeding syndrome (RS) is a significant predictor of postnatal growth failure at discharge and the development of BPD in ELBW infants.
  • These findings highlight the importance of vigilant monitoring and management of RS in this vulnerable population.
  • Long-term follow-up is recommended for infants experiencing RS to assess long-term outcomes.
Abstract

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